Osimertinib as Neoadjuvant Therapy for Resectable Non-Small Cell Lung Cancer: A Case Series

Abstract

Background: Evidence of osimertinib as neoadjuvant therapy for resectable non-small cell lung cancer (NSCLC) are currently lacking. This case series study aimed to assess the safety and feasibility of neoadjuvant osimertinib therapy followed by surgery for resectable NSCLC.Materials and methods: Patients with resectable NSCLC with epidermal growth factor receptor (EGFR) mutation who received osimertinib as neoadjuvant therapy followed by surgery at our center were included. Demographic features, radiologic and pathological assessment of response, surgery-related details and complications, toxicity profiles, and prognostic outcomes were extracted.Results: A total of 13 patients were included in this study. The median age at the time of surgical resection was 57 years (interquartile range: 52–64 years), and eight (61.5%) patients were female. The objective response rate (ORR) was 69.2% (9/13), and the complete resection rate was 100%. The rates of pathologic downstaging and lymph node downstaging were 100% (13/13) and 66.7% (6/9), respectively. There were no perioperative deaths and only three (23.1%) patients had postoperative complications. Seven (53.8%) and 13 (100%) patients experienced grade 1 treatment-related adverse reactions and laboratory abnormalities, respectively. No patients experienced drug withdrawal or surgical delays due to the adverse events. No patients showed grade 2 or worse toxicity profiles. One patient was lost to follow-up. The other 12 patients were alive and free of disease recurrence with a median follow-up time of 9.5 months.Conclusion: Neoadjuvant osimertinib therapy seemed to be safe and feasible for resectable EGFR-mutated NSCLC. Future large prospective studies are warranted to confirm whether osimertinib as neoadjuvant therapy outperforms standard tyrosine kinase inhibitors (TKIs) or chemotherapy for resectable EGFR-mutated NSCLC.

Pathological complete response in an advance stage IIIB non‐small cell lung cancer secondary to neoadjuvant osimertinib targeted therapy: A case report and review of literature

“…Although there is still a paucity of data on EGFR‐TKI‐NTT, some early reports supported its role 3–6 . In a case series of 13 patients, Hu et al has reported a 69.2% objective response rate, 100% complete resection rate and 100% pathologic downstaging rate with the use of osimertinib‐NTT 7 . When compared to conventional neoadjuvant chemotherapy, EGFR‐TKI‐NTT demonstrated higher objective response rate and median progression‐free survival 4 .…”

A graphSAGE discovers synergistic combinations of Gefitinib, paclitaxel, and Icotinib for Lung adenocarcinoma management by targeting human genes and proteins: the RAIN protocol

“…There is a requirement for new therapeutic advancements for patients with EGFR-mutant NSCLC and liver metastases. [145][146][147][148][149][150][151][152] Crizotinib, a small molecule tyrosine kinase inhibitor, specifically addresses aberrant proteins in cancerous cells. Employed as an initial treatment, it is utilized in the management of non-small cell lung carcinoma (NSCLC) that meets certain genetic mutation criteria.…”

Feasibility and safety of EGFR-TKI neoadjuvant therapy for EGFR-mutated NSCLC: a meta-analysis

“…The reasons for exclusion included a lack of information on the speci c EGFR-TKI used as an intervention, absence of surgical resection after EGFR-TKI treatment, or being intermediate analyses of another study. Finally, a total of 11 studies, involving 344 patients with EGFR-positive mutated NSCLC, met the inclusion criteria and were included in this metaanalysis [13,[17][18][19][20][21][22][23][24][25][26] . The PRISMA owchart depicting the literature selection process is shown in Figure 1.…”